Acute Kidney Injury Raises Heart Failure Risk

AKI is independently associated with a 27% increased risk of heart failure, according to a study of hospitalized U.S. veterans.
AKI is independently associated with a 27% increased risk of heart failure, according to a study of hospitalized U.S. veterans.

SAN DIEGO—Acute kidney injury (AKI) is an independent risk factor for incident heart failure (HF), according to study findings presented at Kidney Week.

Nisha Bansal, MD, of the University of Washington in Seattle, and colleagues studied a national retrospective cohort of 1.2 million U.S. veterans hospitalized from 2003–2012 without a history of HF. From this cohort, the researchers matched 116,697 AKI patients with the same number of patients without AKI using 32 relevant inpatient and outpatient covariates.

Dr. Bansal's group defined AKI as a 0.3 mg/dL or 50% increase in serum creatinine using the difference between peak hospitalization and baseline creatinine as determined by mean outpatient creatinine over the previous year. They defined incident HF as more than 1 hospitalization or more than 2 visits with a diagnosis of HF.

Patients in the matched pairs had a median age of 63 years; 21% were African-American. The median pre-admission estimated glomerular filtration rate was 72 mL/min/1.73 m2. Over a median follow-up time of 1.74 years, HF developed after hospital discharge in 5% of patients with AKI compared with 3% of those without AKI, a difference that translated into a significant 27% increased risk of HF among the AKI patients after adjusting for potential confounders. Additionally, AKI was associated with a significant 30% increased risk of a composite outcome of HF and death.

“AKI is an independent risk factor for incident HF adding further evidence to the long-term cardiovascular consequences of this disease,” the authors concluded in a poster presentation. “Future studies to identify underlying mechanisms and modifiable risk factors for AKI survivors at highest risk for incident HF are needed.”
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